Single-test outliers in District of Columbia Medicaid data. These are individual statistical flags β most are informational.
Important context: These findings identify statistically unusual billing patterns, not determinations of wrongdoing. Cost-per-claim comparisons may flag hospital outpatient departments whose reimbursements include facility fees, bundled services, or all-inclusive rates. High claims-per-beneficiary ratios may reflect legitimate care patterns at behavioral health facilities, pediatric specialty centers, or residential care programs. Additional investigation and clinical context are required before drawing any conclusions.
For provider level analytics using multiple independent tests, see the Watchlist β which flags providers only when 2+ different detection methods agree. These single-test outliers below are primarily informational; only Cost Outliers and Overutilization are flagged as critical/warning.
critical
32
warning
73
info
692
Total
797
LIFELINE, INC (1407430143): 88.7 claims/beneficiary (avg 3.5). 171,039 claims, 1,928 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
WASHINGTON HOSPITAL CENTER CORPORATION (1881701217) bills $350.20/claim for 99213 (Office o/p est low 20 min) vs avg $49.81 (+6.7Ο). $16,459 across 47 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
CHILDREN'S HOSPITAL (1912939703) bills $347.79/claim for 99213 (Office o/p est low 20 min) vs avg $49.81 (+6.7Ο). $4,338,670 across 12,475 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
MARY'S CENTER FOR MATERNAL AND CHILD CARE (1053522060) bills $219.68/claim for D0999 (Unspecified diagnostic proce) vs avg $5.36 (+6.3Ο). $6,309,556 across 28,721 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
CHILDREN'S HOSPITAL (1912939703) bills $302.88/claim for 90832 (Psytx w pt 30 minutes) vs avg $37.58 (+6.1Ο). $383,444 across 1,266 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
PROVIDENCE HOSPITAL (1932190626) bills $38.39/claim for 99173 (Visual acuity screen) vs avg $2.74 (+5.8Ο). $14,742 across 384 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
SOME, INC (1134607401) bills $393.16/claim for T1015 (Clinic service) vs avg $76.70 (+5.5Ο). $399,845 across 1,017 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
PROVIDENCE HOSPITAL (1932190626) bills $74.11/claim for 92551 (Pure tone hearing test air) vs avg $7.64 (+5.2Ο). $26,160 across 353 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
GINA OUTREACH, INC (1538589270): 33.1 claims/beneficiary (avg 3.5). 9,928 claims, 300 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
MARY'S CENTER FOR MATERNAL & CHILD CARE, INC (1770976938) bills $276.72/claim for 99213 (Office o/p est low 20 min) vs avg $49.81 (+5.1Ο). $90,488 across 327 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
DJT HEALTH SERVICES INC (1780153916) bills $1,049.05/claim for H2014 (Skills train and dev, 15 min) vs avg $76.25 (+5.0Ο). $116,445 across 111 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
MERCY SERVICES OF HEALTH (1407286958) bills $651.30/claim for T1019 (Personal care ser per 15 min) vs avg $145.73 (+4.9Ο). $3,673,315 across 5,640 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
SHARMIN DENTAL CLINIC, P.C. (1588724116) bills $36.03/claim for D0230 (Intraoral - periapical each addl image) vs avg $11.14 (+4.7Ο). $127,233 across 3,531 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
UNITED HOSPITALISTS MEDICAL SERVICE, PLLC (1043555071) bills $202.33/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $43.91 (+4.6Ο). $216,492 across 1,070 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
NOT-FOR-PROFIT HOSPITAL CORPORATION (1801104732) bills $246.10/claim for 99211 (Off/op est may x req phy/qhp) vs avg $25.69 (+4.5Ο). $96,472 across 392 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
MEDSTAR - GEORGETOWN MEDICAL CENTER, INC. (1427145176) bills $228.03/claim for 99202 (Office o/p new sf 15 min) vs avg $45.07 (+4.2Ο). $274,998 across 1,206 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
HOWARD UNIVERSITY HOSPITAL CORP (1487740957) bills $246.67/claim for 99212 (Office o/p est sf 10 min) vs avg $36.92 (+4.1Ο). $19,240 across 78 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
PROVIDENCE HOSPITAL (1932190626) bills $179.38/claim for 90853 (Group psychotherapy) vs avg $29.57 (+4.1Ο). $120,900 across 674 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
NOT-FOR-PROFIT HOSPITAL CORPORATION (1801104732) bills $229.62/claim for 99213 (Office o/p est low 20 min) vs avg $49.81 (+4.0Ο). $2,892,011 across 12,595 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
PARADISE AT GEORGIA AVE, LLC (1174082549): 31.8 claims/beneficiary (avg 3.5). 33,476 claims, 1,054 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
SOUTHERN AVE SP LLC (1306433644): 30.9 claims/beneficiary (avg 3.5). 106,954 claims, 3,466 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
MT&G ENTERPRISE, INC (1831351022): 30.1 claims/beneficiary (avg 3.5). 40,590 claims, 1,350 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DISTRICT OF COLUMBIA CARES CENTER INC. (1497125611): 29.9 claims/beneficiary (avg 3.5). 8,503 claims, 284 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
ABRAMS HALL AL OPCO LLC (1477298743): 29.8 claims/beneficiary (avg 3.5). 30,372 claims, 1,020 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
2905 ALF, LLC (1851729529): 29.8 claims/beneficiary (avg 3.5). 2,237 claims, 75 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
AMERICAN HEALTH CARE SERVICES INC (1295969939): 29.2 claims/beneficiary (avg 3.5). 20,495 claims, 703 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DC HEALTH CARE INC (1194102905): 29.2 claims/beneficiary (avg 3.5). 58,022 claims, 1,988 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
AZURE, LLC (1073637674): 28.8 claims/beneficiary (avg 3.5). 24,238 claims, 843 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
IYA HOMES AND COMMUNITY SOLUTIONS, LLC (1659990695): 27.8 claims/beneficiary (avg 3.5). 46,360 claims, 1,667 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
METRO HOMES INC (1225213325): 27.6 claims/beneficiary (avg 3.5). 86,220 claims, 3,123 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DIDNITY HEALTH CARE LLC (1730842253): 27.6 claims/beneficiary (avg 3.5). 4,024 claims, 146 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
KENILWORTH AVENUE NORTH SERVICES (1538881016): 27.5 claims/beneficiary (avg 3.5). 31,686 claims, 1,152 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
REGINALD WILLS (1124151683) bills $206.13/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $60.84 (+4.0Ο). $15,872 across 77 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
AMAZING GRACE SUPPORTS INC (1801260013): 26.6 claims/beneficiary (avg 3.5). 98,385 claims, 3,701 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
INTEGRATED COMMUNITY SERVICES, INC. (1861926214): 26.5 claims/beneficiary (avg 3.5). 18,368 claims, 692 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
MY OWN PLACE, INC. (1114131281): 26.4 claims/beneficiary (avg 3.5). 114,145 claims, 4,330 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DIVINE CONNECT CARE INC (1215356969): 26.1 claims/beneficiary (avg 3.5). 313 claims, 12 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DISTRICT HOSPITAL PARTNERS L P (1487640207) bills $220.94/claim for 99213 (Office o/p est low 20 min) vs avg $49.81 (+3.8Ο). $1,590,743 across 7,200 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
DISTRICT HOSPITAL PARTNERS L P (1487640207) bills $346.95/claim for 99215 (Office o/p est hi 40 min) vs avg $99.94 (+3.8Ο). $144,333 across 416 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
360 SUPPORT INC (1578021168): 25.2 claims/beneficiary (avg 3.5). 2,348 claims, 93 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
WARD & WARD ASSOCIATION, INC. (1902081680): 25.1 claims/beneficiary (avg 3.5). 93,964 claims, 3,751 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
NATION CARE INC (1285968917): 24.6 claims/beneficiary (avg 3.5). 2,019 claims, 82 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
VOLUNTEERS OF AMERICA CHESAPEAKE, INC. (1124274410): 24.4 claims/beneficiary (avg 3.5). 23,464 claims, 962 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
NOT-FOR-PROFIT HOSPITAL CORPORATION (1801104732) bills $244.75/claim for 99214 (Office o/p est mod 30 min) vs avg $70.49 (+3.6Ο). $571,007 across 2,333 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
MANISHA SINGAL (1104029172) bills $190.63/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $60.84 (+3.6Ο). $59,666 across 313 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
AHMED TAMIM (1336405976) bills $27.05/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $129.84 (-3.5Ο). $52,999 across 1,959 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
GLOBAL RESOURCES & SUPPORT LLC (1568845600) bills $693.66/claim for H0025 (Behavioral health prevention education service (delivery of services with) vs avg $183.84 (+3.5Ο). $65,204 across 94 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
WAVECARE HEALTHCARE SERVICES (1144498817) bills $101.77/claim for A4927 (Non-sterile gloves) vs avg $25.49 (+3.5Ο). $107,980 across 1,061 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
GALAXY HEALTH CARE SOLUTIONS,INC (1609284082): 23.6 claims/beneficiary (avg 3.5). 25,824 claims, 1,095 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
SASSAN TAGHIZADEHMOGHADDAM (1992722557) bills $162.88/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $43.91 (+3.4Ο). $15,800 across 97 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.